老年原发性肝癌的临床资料分析176例

目的:总结老年人原发性肝癌的临床资料,分析影响老年人原发性肝癌预后的临床特点,探讨影响老年人原发性肝癌患者预后的临床因素.方法:总结分析176例老年原发性肝癌患者的临床特点,包括年龄、性别、肝炎病毒感染、肝硬化程度、肿瘤大小以及接受不同的治疗方法.结果:在所有确诊肝癌的患者中,94.9%有肝炎病毒(HBV及HCV)感染史,63.6%有慢性肝炎病史,56.8%合并肝硬化或肝纤维化.接受手术治疗患者的1、2、5年生存率分别为83.1%、66.0%及28.8%;接受介入治疗的患者的1、2、5年生存率分别为73.0%、56.2%及10.1%;采取保守治疗患者则为14.3%、7.1%、0%.小肝癌患者5年生存率明显高于大肝癌及巨大肝癌患者.结论:HBV感染是导致老年人原发性肝癌的主要原因.手术治疗是提高患者生存率的重要方法,介入治疗同样可以取得理想效果.     

老年食管癌患者外科治疗的临床特征及预后因素

目的回顾性研究70岁及以上老年食管癌患者外科治疗的临床特征和预后因素。方法收集171例70岁及以上老年食管癌患者的临床资料,分析高龄食管癌患者的手术治疗特点、围术期死亡率。采用Kaplan-Meier法进行生存分析,Log-rank检验各组生存率,采用Cox回归模型进行预后危险因素分析。结果总体1、3、5年生存率分别为82.5%、53.2%和41.4%,平均生存时间为(63.443±4.203)个月,中位生存时间为(44.6±7.57)个月。单因素分析结果显示,性别、病理类型、术前并发症、术后并发症、是否行根治术、肿瘤分化程度、肿瘤浸润深度、淋巴结转移度(淋巴结转移数占总清除淋巴结数比例)、病理分期和淋巴结转移数是术后生存时间的影响因素(P0.05)。多因素分析结果显示,病理类型、病理分期是患者预后的重要独立危险因素(P0.05)。术后并发症发生率为17.4%(30/172),围术期死亡率为1.7%(3/172)。结论老年食管癌患者选择性手术治疗可获得理想的长期生存,病理类型和病理分期是患者预后的重要独立危险因素。     

手术治疗老年女性乳腺癌患者的临床特征、术后治疗情况、预后及其影响因素分析

目的分析手术治疗的老年女性乳腺癌患者的临床特征、术后治疗情况、预后以及影响预后的相关因素。方法回顾性分析我院收治的399例65岁以上手术治疗的老年女性乳腺癌患者的临床资料,分析其临床特征、术后治疗情况和预后,对影响老年女性乳腺癌患者预后的因素进行多因素Logistic回归分析。结果老年乳腺癌患者多为65～70岁,单纯左、右乳患病居多,双侧乳患病较少,肿瘤直径多数为2～5 cm,65. 16%无淋巴结转移,分期多属Ⅰ期或Ⅱa期,以浸润性导管癌较为常见,分子类型多为Luminal A型或Luminal B HER-2(-)型。手术治疗后大部分患者能接受辅助治疗(放疗、化疗、内分泌治疗),患者的1年、3年和5年的无病生存率分别为96. 23%、92. 48%和86. 59%,总生存率分别为96. 99%、90. 65%和85. 47%。多因素Logistic回归分析结果显示,肿瘤大小、淋巴结转移、TNM分期、分子分型是影响患者预后的独立因素。结论手术治疗的老年女性乳腺癌病理类型以浸润性导管癌为主,手术治疗后大部分患者能接受辅助治疗,预后较好。肿瘤大小、淋巴结转移、TNM分期、分子分型是影响手术治疗老年女性乳腺癌患者预后的独立因素。     

Ⅰa期非小细胞肺癌患者预后因素的相关分析

目的 探讨临床病理特征、手术方式及辅助化疗对Ⅰ a期非小细胞肺癌患者预后的影响.方法 回顾性分析在上海市肺科医院胸外科经手术治疗的Ⅰ a期非小细胞肺癌患者98例.用Pearson X2分析肿瘤大小的分布差异,用Kaplan-Meier生存曲线统计生存率,Log-rank进行差异性检验,并对患者发病年龄、性别、病理类型、肿瘤大小、肿瘤部位、手术方式以及是否接受辅助化疗等因素进行COX回归比例风险模型多因素分析.结果 全组总的5年生存率为68.4%;肿瘤≤2.0 cm组5年生存率为75.9 0A,＞2.0 cm且≤3.0 cm组为58.8%;行肺叶切除加纵隔淋巴结采样组5年生存率为53.0%,行肺叶切除加系统纵隔淋巴结清扫组5年生存率为80.4%.单因素及多因素分析,肿瘤大小、手术方式均为独立的预后因素.结论 肿瘤大小、手术方式均为Ⅰ a期非小细胞肺癌患者独立的预后因素,要求进一步提高肺癌诊断水平,积极行系统纵隔淋巴结清扫术,使患者及早获得更彻底的治疗.     

老年喉癌颈部淋巴结转移的临床分析

目的探讨老年喉癌颈部淋巴结转移治疗方法的远期疗效及预后影响因素。方法回顾性分析适合纳入条件的33例老年喉癌的临床资料,选择年龄、性别、病理类型、肿瘤原发部位、颈部淋巴结转移部位、肿瘤临床分期、治疗方案作为分析指标,采用单因素分析及Cox风险模型,分析影响老年喉癌颈部淋巴结转移的预后因素。结果 33例患者失访2例,随访率为93.9%,老年喉癌颈部淋巴结转移的3年生存率为80.6%,5年生存率为51.6%,单因素分析显示年龄、病理类型、临床分期、治疗方式与老年喉癌颈部淋巴结转移预后有关(P0.05),性别、肿瘤原发部位、颈部淋巴结转移部位与预后无关(P0.05),多因素分析结果显示:病理类型、治疗方式是影响预后的独立因素。结论影响老年喉癌颈部淋巴结转预后的独立因素是病理类型及治疗方式,对于老年喉癌伴颈部淋巴结转移的患者应及早诊断和早期治疗干预。     

60岁以上原发性肝癌患者的预后影响因素分析

目的探讨60岁以上原发性肝癌患者的预后影响因素。方法 146例60岁以上原发性肝癌患者,比较不同年龄、性别、病理类型、合并基础疾病、肝功能Child-Pugh分级、肿瘤直径、治疗方式、AFP水平及有无肝炎病毒感染史、肝外转移患者1、2、5年累积生存率的差异,采用多元逐步Cox回归模型探讨影响原发性肝癌患者预后的相关因素。结果不同肿瘤直径、治疗方式、AFP水平和肝外转移情况的60岁以上原发性肝癌患者生存率比较差异有统计学意义(P均<0.05)。介入治疗(RR=1.41,95%CI:1.01~1.97)和保守治疗(RR=3.32,95%CI:1.92~5.76)(均相较于手术治疗),以及伴肝外转移(RR=1.93,95%CI:1.08~3.45)为60岁以上原发性肝癌患者预后的危险因素。结论肝外转移、非手术治疗的60岁以上原发性肝癌患者预后风险增加。     

原发性大肝癌调强放疗的疗效及预后分析

目的探讨调强放射治疗对不适宜手术以及射频消融、介入等其他局部治疗无效的原发性大肝癌的临床疗效及预后影响因素。方法回顾性分析2008年4月-2011年8月武警总医院肿瘤内科收治的29例接受调强放疗的原发性大肝癌患者的临床资料。单次剂量2~6 Gy,5 F/w,总剂量50~70 Gy。观察近期疗效及预后。生存率计算采用Kaplan-Meier法,差异性检验采用Log-rank法,并采用Cox回归模型进行多因素分析。结果完全缓解率3.57%,部分缓解率32.14%,疾病稳定率53.57%,进展率10.72%,总体中位无进展生存时间(PFS)6.43个月,中位生存期(OS)11.43个月,1、2年生存率分别为46.79%和25.23%。单因素分析显示肿瘤缓解率为PFS的独立预后因子,Cox多因素分析显示PFS的独立预后因子为肿瘤缓解率和处方剂量,OS的独立预后因素为肿瘤缓解率、肿瘤直径、肿瘤体积。常见放疗急性不良反应为胃肠道不适、放射性肝损伤及骨髓抑制。结论调强放疗对于不能手术治疗及其他局部治疗无效的原发性大肝癌是一个安全、有效的选择。     

HBV cccDNA的水平及临床因素对肝细胞癌术后预后的判断价值

目的:研究HBV cccDNA水平及临床因素对肝细胞癌术后预后的影响.方法:回顾性分析2003-2006年我院收治60例术后病理证实原发性肝癌患者,采用荧光定量PCR检测乙型肝炎病毒(hepatitis B virus,HBV)共价闭合环状DNA(cccDNA)和HBV DNA;55例获得完整随访,选择血清HBV DNA、肝组织cccDNA及临床、病理特征等指标分析其对无瘤生存率、总体生存率的影响.采用Kaplan-Meier法计算无瘤生存率、总体生存率,Log-rank检验比较组间差异,多因素分析采用Cox回归模型.结果:血清cccDNA仅有1例阳性(1/35),肝癌组织cccDNA阳性率20.0%(11/55),肝癌组织cccDNA与血清HBV DNA之间存在相关性(r=0.364;P=0.006).全组1、3、5年总体生存率为73%、51%和38%,无瘤生存率为63%、29%和19%;多因素分析结果表明,肿块数目(P=0.011)、血管侵犯(P=0.001)是影响术后总体生存率的独立危险因素;癌组织cccDNA水平(P=0.007)、生长方式(P=0.002)是影响术后无瘤生存率的独立危险因素.结论:单发肿瘤、无血管侵犯的患者术后总体生存率较高.癌组织cccDNA水平<3log10copies/μg、肝癌膨胀性生长的患者术后无瘤生存率较高.     

胃间质瘤外科手术治疗与预后相关性因素分析

目的分析胃间质瘤外科手术治疗及预后的相关性因素。方法收集2008-06~2014-06于该院行手术治疗并经病理检查明确为胃间质瘤的62例患者的临床资料,统计并分析影响患者预后的因素。结果所有患者均行手术治疗,平均随访时间为38.6(40.69±6.23)个月,随访率为96.77%。其1、3、5年总体生存率分别为91.45%、72.84%、60.47%。单因素分析显示,肿瘤细胞核分裂像、肿瘤大小、肿瘤坏死及NIH危险度分级是影响患者生存预后的因素。生存率与年龄、性别、生长类型等因素无明显相关差异。COX回归分析提示,核分裂像、NIH危险度分级是影响预后的独立因素,χ~2分别为7.148和6.347(P0.05)。相对危险度(RR)分别为3.276和4.266;95%CI分别为1.437~7.476和1.271~10.622。结论胃间质瘤的总体预后一般,肿瘤细胞核分裂像、肿瘤大小、肿瘤坏死及NIH危险度分级是影响胃间质瘤术后的预后因素,其中,核分裂像、NIH危险度分级是影响预后的独立因素。     

手术治疗巴塞罗那B期肝细胞癌患者的生存状况

目的探讨手术治疗巴塞罗那(BCLC)B期肝癌患者生存状况的影响因素,旨在为BCLC B期肝癌患者选择治疗方案和预后评估提供依据。方法选择于我院2012年3月至2015年3月收治的126例行手术根除治疗的巴塞罗那B期肝癌患者,分析影响患者预后的临床因素。结果 126例BCLC B期患者1、3、5年生存率分别为82.5%(104/126)、52.4%(66/126)和41.3%(52/126),中位生存期为28(3～58)个月。单因素分析结果显示,年龄、肿瘤最大直径、肿瘤数目、合并糖尿病、AFP、AST及ALT与总生存期有关(P0.05),其他因素与总生存期无显著相关性(P0.05)。多因素分析显示,肿瘤最大直径、肿瘤数目、AFP、AST及ALT是影响BCLC B期患者预后的独立危险因素(P0.05)。根据上述危险因素将BCLC B期肝癌患者分为低危组(≤1个危险因素,n=46)和高危组(≥2个危险因素,n=80)。低危组1、3、5年生存率分别为87.0%(40/46)、73.9%(34/46)和65.2%(30/46),中位生存期为34(16～58)个月。高危组1、3、5年生存率分别为80.0%(64/80)、40.0%(32/80)和27.5%(22/80),中位生存期为22(2～46)个月。低危组和高危组的生存率比较差异有统计学意义(P0.05)。结论肿瘤最大直径、肿瘤数目、AFP、AST及ALT是影响BCLC B期患者预后的独立危险因素,监测上述指标对于预测临床结局有重要价值。     

P53 immunohistochemical scoring：an independent prognostic marker for patients after hepatocellular carcinoma resection

AIM：To confirm if p53 mutation could be a routine predictive marker for the prognosis of hepatocellular carcinoma(HCC) patients.METHODS:Two hundreds and forth-four formalin-fixed paraffin-embedded tumor samples of the patients with HCC receiving liver resection were detected for nuclear accumulation of p53,The percent of p53 immunoreactive tumor cells was scored as 0 to 3+in p53 positive region(&lt;10%-,10-30%+,31-50%++,&gt;50%+++),Proliferating cell nuclear antigen(PCNA) and some clinicopathological characteristics,including patients‘sex,preoperative serum AFP level,tumor size,capsule,vascular invasion(both visual and microscopic),and Edmondson grade were also evaluated.RESULTS:In univariate COX harzard regression model anlaysis,tumor size Capsule status,Vascular invasion,and P53 expression were independent factor that were closely related to the overall survival(OS) rates of HCC patients.The Survival rtea of patients with 3+ for P53 expression were much lower than those with 2+or+for capsule(P&lt;0.01)were closely related to the disease-free survival(DFS) of HCC patients.IN multivariate analysis,P53 overexpression (RI 0.5456,P&lt;0.01),was the most significant factor associated with the OS rates of patients after HCC resection,While tumor size(RI 0.5209,P&lt;0.01),vascular invasion (RI0.5271,P&lt;0.01)and capsule(RI-0.8691,P&lt;0.01)were also related to the OS.However,only tumor capsular status was an independent predictive factor (P&lt;0.05),for the DFS.No significant prognostic value was found in PCNA-LI,Edmondson‘s grade,patients‘ sex and preoperative serum AFP level.CONCLUSION:Accumulation of p53 expression,as well as tumor size,capsule and vascular invasion,could be valuable markers for predicting the prognosis of HCC patients after resection.The quantitative immunohistochemical scoring for p53 nuclear accumulation might be more vaiuable for predicting prognosis of patients after HCC resection than the common qualitative analysis.     

High expression of TRAF4 in hepatocelullar carcinoma as an independent negative survival and recurrence predictor

Objective: To identify potential tumor markers for the development and recurrence of hepatocelullar carcinoma(HCC), this research studied the relationship between the expression of the tumor necrosis factor receptor-associated factor 4(TRAF4) and tumor angiogenesis together with its survival time of HCC patients. Methods: The expressions of TRAF4,vascular endothelial growth factor and CD34 were performed upon 90 patients with curative liver resection between August 2006 and November 2009 by immunohistochemical method in locally advanced HCC and adjacent non-tumoral liver. The expression of TRAF4 was determined by the Spearman rank correlation. Their prognostic factors on disease free survival(DFS) and overall survival(OS) were guaranteed by Kaplan-Meier and Cox regression analyses. The detection of the levels of vascular endothelial growth factor and CD34 was fulfilled in 90 cases of HCC. Results: TRAF4 expression was both significantly higher in HCC than in surrounding non-tumor tissues(57.8% vs. 22.2 %; P0.001) and significantly correlated with tumor size and tumor staging. High TRAF4 was correlated with reduced DFS rate(P=0.001) and overall OS rate(P0.001) and were displayed in Kaplan-Meier survival analysis. Conclusions: TRAF4 is involved with multifarious clinicopathologic features.TRAF4 expression, as an independent adverse prognostic factor, DFS and OS in HCC, is associated with increased tumor angiogenesis. The combined detection of TRAF4 in locally advanced HCC is a trustworthy predictive factor for the tumor development and recurrence.     

High level of intercellular adhesion molecule-1 affects prognosis of patients with hepatocellular carcinoma

AIM: To determine the cut-off value of intercellular adhesion molecule-1 (ICAM-1) and assess the correlation of ICAM-1 with clinicopathological features and the prognosis of hepatocellular carcinoma (HCC) patients who underwent surgical resection.METHODS: We prospectively collected clinicopathological data from 236 HCC patients who had undergone successful hepatectomy. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of ICAM-1. Enzyme-linked immunosorbent assay was used to measure the concentration of ICAM-1 in 236 serum samples isolated from HCC patients and the stratified analysis was used to compare the serum level of ICAM-1 in different HCC subgroups. Immunohistochemistry was performed to test the expression level of the ICAM-1 protein in 76 cases of HCC tissues and their adjacent normal liver tissues (ANLT). The survival probability of HCC patients was estimated using Kaplan-Meier plots and differences between the groups were obtained using the log-rank test. Furthermore, independent indicators of the prognosis were acquired using a stepwise Cox proportional hazard model to analyze a series of predictors that were associated with disease-free survival (DFS) and overall survival (OS) in HCC patients.RESULTS: Our findings suggested that ICAM-1 promotes HCC metastasis and high serum ICAM-1 is significantly associated with alpha-fetoprotein (AFP) (P = 0.022), clinical tumor-node-metastasis stage (P < 0.001), portal vein tumor thrombus (P = 0.005), distant metastasis (P = 0.016) and recurrence (P = 0.034). We further detected the ICAM-1 protein in HCC specimens and found that 56 of 76 (73.7%) HCC tissues had ICAM-1 positive staining while only 23 of 76 (30.3%) ANLT were positively stained (P < 0.0001). Survival analysis indicated that HCC patients with increased ICAM-1 concentrations had significantly shorter DFS and OS after resection. A multivariate analysis showed that ICAM-1 > 684 ng/mL was an independent factor for DFS (HR = 1.643; 95%CI: 1.125-2.401; P = 0.010) and OS (HR = 1.692; 95%CI: 1.152-2.486; P = 0.007).CONCLUSION: ICAM-1 may be a promising serological biomarker for HCC diagnosis and an independent predictor of DFS and OS after surgical resection and may provide a useful reference for the prediction of intra- and extrahepatic metastasis.     

Portal hypertension predicts short-term and long-term outcomes after hepatectomy in hepatocellular carcinoma patients

Background and aims: The impact of portal hypertension (PH) on postoperative short-term outcomes and long-term survival in hepatocellular carcinoma (HCC) patients has lately been discussed controversially. This study aimed to explore the influence of PH on postoperative outcomes in HCC patients undergoing surgical resection.

Methods: Patients undergoing hepatectomy for HCC from 2010 to 2014 were enrolled. The impact of PH on postoperative complications, posthepatectomy liver failure (PHLF) and overall survival (OS) was evaluated.

Results: A total of 355 HCC patients were enrolled; 129 (36.3%) experienced postoperative complications and 21 (5.9%) developed PHLF. PH was identified as an independent predictor of PHLF. Patients with PH experienced a higher incidence of complications and PHLF than patients without PH. On the Cox proportional hazards regression model, PH was verified as a risk factor of OS for BCLC stage 0/A and B patients. Patients without PH had significantly better long-term survival compared to patients with PH both in the total cohort and in cirrhosis subgroup.

Conclusion: Liver resection in HCC patients with PH showed a significantly increased postoperative complications and PHLF, and revealed a decreasing long-term survival than non-PH patients. Besides, tumor burden also played an important role in determining the OS. However, due to the improvement in surgical technique and perioperative management, surgery was feasible in carefully selected HCC patients with PH.     

Primary clear cell carcinoma of liver--clinicopathologic features and surgical results of 18 cases

BACKGROUND/AIMS: Primary clear cell carcinoma of the liver (PCCCL) is a subgroup of hepatocellular carcinoma. At present, little is known about the relationship between the prognosis and the treatment of PCCCL. The purpose of the study was to analyze the clinical and pathological features, and to discuss the relationship between the prognosis and the surgical treatment of PCCCL. METHODOLOGY: Eighteen cases with pathologically proved PCCCL between March 1999 and January 2003 were enrolled, the preoperative and intraoperative clinical features, pathological features and the follow-up data were analyzed. RESULTS: Histological examinations showed PCCCL was characterized by large numbers of vacuolated clear cells. The differentiation degree ranged from grade 1 to 3, liver cirrhosis or/and chronic hepatitis was present in paratumorous tissues. The 1- and 2-year survival rates were 76.5% (13/18) and 47.1% (8/18) respectively, and the median survival time was 23 months. The longest survival time was 97 months after surgery. Among the 13 cases with radical resection, nine cases had recurrence. CONCLUSIONS: The clear cells of PCCCL contain substantial quantities of glycogen and lipid. The clinical characteristics of the PCCCL are similar to those of conventional hepatocellular carcinoma. Surgical resection is an effective way to achieve favorable outcomes and even long-term survival of the patients with PCCCL.     

Intermittent Hepatic Inflow Occlusion During Partial Hepatectomy for Hepatocellular Carcinoma Does Not Shorten Overall Survival or Increase the Likelihood of Tumor Recurrence

Aim: To investigate whether the long-term outcomes of hepatocellular carcinoma (HCC) was adversely impacted by intermittent hepatic inflow occlusion (HIO) during hepatic resection.Methods: 1549 HCC patients who underwent hepatic resection between 1998 and 2008 were identified from a prospectively maintained database. Intermittent HIO was performed in 931 patients (HIO group); of which 712 patients had a Pringle maneuver as the mechanism for occlusion (PM group), and 219 patients had selective hemi-hepatic occlusion (SO group). There were 618 patients that underwent partial hepatectomy without occlusion (occlusion-free, OF group).Results: The 1-, 3-, and 5- year overall survival (OS) rates were 79%, 59%, and 42% in the HIO group, and 83%, 53%, and 35% in the OF group, respectively. The corresponding recurrence free survival (RFS) rates were 68%, 39%, and 22% in the HIO group, and 74%, 41%, and 18% in the OF group, respectively. There was no significant difference between the 2 groups in OS or RFS (P = 0.325 and P = 0.416). Subgroup analysis showed patients with blood loss over 3000 mL and those requiring transfusion suffered significantly shorter OS and RFS. Blood loss over 3000 mL and blood transfusion were independent risk factors to OS and RFS.Conclusions: The application of intermittent HIO (PM and SO) during hepatic resection did not adversely impact either OS or RFS in patients with HCC. Intermittent HIO is still a valuable tool in hepatic resection, because high intraoperative blood loss resulting in transfusion is associated with a reduction in both OS and RFS.     

Morphologic classification of microvessels in hepatocellular carcinoma is associated with the prognosis after resection

Background and Aim: The relationship between neovasculature in hepatocellular carcinoma (HCC) and the prognosis of patients still remains controversial. The aim of the present study was to investigate the prognostic significance of morphologic features of the microvessels in patients with HCC after resection. Methods: The paraffin‐embedding specimens of 98 consecutive HCC patients, who received primary resection between 2000 and 2002, were collected from our prospective established tumor bank. The intratumoral microvessels were evaluated by immunohistochemical staining for CD31 and CD34. The disease‐free survival (DFS) and overall survival (OS) of patients were analyzed by Kaplan–Meier analysis and Cox proportional hazards regression model. Results: There are two distinct microvessel types: capillary‐like and sinusoid‐like were identified in tumor tissues. The patients could be divided into two groups according to their microvessel types. Both DFS and OS of capillary group patients (n = 65) were better than those of sinusoid group patients (n = 33). Multivariate analyses showed that the microvessel type was an independent risk factor for DFS (P = 0.016) and OS (P = 0.004) of this cohort. Capillary‐like microvessels were more common in small HCC, and were significantly associated with higher microvessel density, while sinusoid‐like microvessels were significantly correlated with lower microvessel density. Conclusions: The results of our study suggested that the microvessel type is an effective predictor of survival in patients with HCC after resection, which might serve as potential novel therapeutic targets for prevention of the recurrence of HCC after resection.     

Prognosis of hepatocellular carcinoma with bile duct tumor thrombus after R0 resection:a matched study

BACKGROUND: Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The present study aimed to determine post-surgical prognoses in HCC patients with BDTT, as outcomes are currently unclear.
METHODS: We compared the prognoses of 110 HCC patients without BDTT (group A) to 22 cases with BDTT (group B). The two groups were matched in age, gender, tumor etiology, size, number, portal vascular invasion, and TNM stage. Addi-tionally, 28 HCC patients with BDTT were analyzed to identify prognostic risk factors.
RESULTS: The 1-, 3-, and 5-year overall survival rates were 90.9%, 66.9%, and 55.9% for group A and 81.8%, 50.0%, and 37.5% for group B, respectively. The median survival time in groups A and B was 68.8 and 31.4 months, respectively (P=0.043). The patients for group B showed higher levels of serum total bilirubin, alanine aminotransferase and gamma-glutamyl transferase, a larger hepatectomy range, and a higher rate of anatomical resection. In subgroup analyses of patients with BDTT who underwent R0 resection, TNM stage III-IV was an independent risk factor for overall survival; these patients had worse prognoses than those with TNM stage I-II after R0 resection (hazard ratio=6.056,P=0.014). Besides, univariate and multivariate analyses revealed that non-R0 resection and TNM stage III-IV were independent risk fac-tors for both disease-free survival and overall survival of 28 HCC patients with BDTT. The median overall survival time of patients with BDTT who underwent R0 resection was longer than that of patients who did not undergo R0 resection (31.0 vs 4.0 months,P=0.007).
CONCLUSIONS: R0 resection prolonged survival time in HCC patients with BDTT, although prognosis remains poor. For such patients, R0 resection is an important treatment that determines long-term survival.     

Post-transplant infection improves outcome of hepatocellular carcinoma patients after orthotopic liver transplantation

BACKGROUND Tumor recurrence after orthotopic liver transplantation(OLT) remains a serious threat for long-term survival of the recipients with hepatocellular carcinoma(HCC), since very few factors or measures have shown impact on overcoming HCC recurrence after OLT. Postoperative infection suppresses tumor recurrence and improves patient survival in lung cancer and malignant glioma probably via stimulating the immune system. Post-transplant infection(PTI), a common complication, is deemed to be harmful for the liver transplant recipients from a short-term perspective. Nevertheless, whether PTI inhibits HCC recurrence after OLT and prolongs the long-term survival of HCC patients needs to be clarified.AIM To investigate the potential influence of PTI on the survival and tumor recurrence of patients with HCC after OLT.METHODSA total of 238 patients with HCC who underwent OLT between August 2002 and July 2016 at our center were retrospectively included and accordingly subdivided into a PTI group(53 patients) and a non-PTI group(185 patients). Univariate analyses, including the differences of overall survival(OS), recurrence-free survival(RFS), and post-recurrence survival(PRS), between the PTI and non-PTI subgroups as well as survival curve analysis were performed by the KaplanMeier method, and the differences were compared using the log rank test. The variables with a P-value 0.1 in univariate analyses were included in the multivariate survival analysis by using a Cox proportional-hazards model.RESULTS The 1-, 3-, and 5-year OS and RFS rates of the whole cohort were 86.6%, 69.0%,and 63.6%, and 75.7%, 60.0%, and 57.3%, respectively. The 1-, 3-, and 5-year OS rates for the PTI patient group(96.0%, 89.3%, and 74.0%) were significantly higher than those for the non-PTI group(84.0%, 63.4%, and 60.2%)(P = 0.033).The absence of PTI was an independent risk factor for dismal OS(relative risk[RR] = 2.584, 95%CI: 1.226-5.449) and unfavorable RFS(RR = 2.683, 95%CI: 1.335-5.390). Subgroup analyses revealed that PTI remarkably improved OS(P = 0.003)and RFS(P = 0.003) rates of HCC patients with vascular invasion(IV), but did not impact on OS(P = 0.404) and RFS(P = 0.304) of patients without VI. Among the patients who suffered post-transplant tumor recurrence, patients with PTI showed significantly better OS(P = 0.026) and PRS(P = 0.042) rates than those without PTI.CONCLUSION PTI improves OS and RFS of the transplant HCC patients at a high risk for posttransplant death and tumor recurrence, which is attributed to suppressive effect of PTI on HCC recurrence.